Duties Description
Under the general supervision of a Claims Services Representative 2, oversees all aspects of workers compensation claims processing from inception to closing; initially determines the compensability of claims and files appropriate documentation with the Workers Compensation Board (WCB); calculates and adjusts reserves consistent with case analysis over the anticipated life of the claim; recommends cases for appeal to WCB; negotiates and/or makes recommendations regarding lump sum settlements; issues payments and requests for reimbursement where claims for supplemental benefits are involved; reviews awards to ensure the correct recipient and rate of compensation; schedules or waives medical examinations as necessary; analyzes medical bills to determine causality, levels of treatment, necessity for treatment, appropriateness of fees and procedure codes, and apportionment status; responds to requests for home modifications, home health care personnel, medication, and medical supplies and appliances; and reviews case activity and determines when a claim can be retired.
Specific duties to be discussed at time of interview.
Minimum Qualifications
For Appointment to Claims Services Representative 1, SG-18:
- Reachable on current Civil Service eligible list for this title; OR
- One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Eligible titles include, but are not limited to: Administrative Specialist 1, Investigator 2 (Compensation Claims), Policyholder Services Representative 1, Underwriter 1, Underwriter 1 (Disability Benefits)
For Appointment To Claims Services Representative Trainee 1:
- Reachable on current Civil Service eligible list for this title; OR
- One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Eligible titles include, but are not limited to: Investigator 1, Assistant Insurance Fund Services Representative, Program Aide; OR
- A bachelor's or higher degree (in any area of study).
Please Note
The salary range shown includes location pay and/or geographic pay.
If you are on the current eligible list for the position title in this location, you must also respond to the canvass letter that you receive to be eligible for list appointment, if reachable. Candidates will not be considered as an acceptor to the canvass based on response to this vacancy posting. If you would like to apply for appointment by one of the qualifications listed above, you must also respond to this vacancy posting as described in the “To Apply” section below.
If you have questions about your eligibility, please contact the Personnel Department at hr@nysif.com.
To Apply
Please send your resume and cover letter to hr@nysif.com and reference the NYSIF Vacancy Posting Number in the subject line of your email.
Additional Information
This title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS).For the duration of the NY HELPS Program, this title maybe filled via a non-competitive appointment, which means no examination is required but all candidates must meet the minimum qualifications of the title for which they apply.
At a future date, it is expected employees hired under NY HELPS will have their non-competitive employment status converted to competitive status, without having to compete in an examination. Employees will then be afforded with all the same rights and privileges of competitive class employees of New York State. While serving permanently in a NY HELPS title, employees may take part in any promotion examination for which they are qualified.
